Eplerenone a Little Better for Systolic Hypertension than Calcium Channel Blocker: In a 24-week DB study of 269 adults with systolic hypertension and widened pulse pressure, eplerenone (50 to 200 mg daily), a highly selective aldosterone blocker, did as well as amlodipine (2.5 to 10 mg daily), a calcium channel blocker, in lowering systolic BP 20 mmHg. Pulse pressure was reduced similarly (eplerenone, -15.9 mm Hg vs. amlodipine, -13.4 mm Hg, P=0.07). In patients with microalbuminuria at baseline (>30 mg albumin/g creatinine), eplerenone reduced the urinary albumin/creatinine ratio by 52% compared with a reduction of 10% by amlodipine (P=0.04). Effects of the selective aldosterone blocker eplerenone versus the calcium antagonist amlodipine in systolic hypertension. White WB, Duprez D, et al. University of Connecticut. Hypertension. 2003 May;41(5):1021-6

Omapatrilat (Vanlev) Vasopeptidase Inhibitor More Effective Than ACE Inhibitor: In small drug company-financed study of 167 patients reports that its medication did better than an ACE inhibitor.  Vanlev blocks the production of the angiotensin II, a hormone that constricts blood vessels. Vanlev also blocks the breakdown of hormones that cause arteries to dilate and become less stiff, Circ 5/02

CoQ10 Appears Helpful: In a meta-analysis of 12 clinical trials (362 patients) comprising three randomized controlled trials, one crossover study and eight open label studies using CoQ10, in the randomized controlled trials (n=120), systolic blood pressure in the treatment group was 168 mm Hg before, and 1518 mm Hg after treatment, a decrease of 16.6 (P<0.001) mm Hg, with no significant change in the placebo group. Diastolic blood pressure in the treatment group was 103 mm Hg before, and 95 mm Hg after treatment (P<0.001) mm Hg, with no significant change in the placebo group. In the crossover study (n=18), systolic blood pressure decreased by 11 mm Hg and diastolic blood pressure by 8 mm Hg (P<0.001) with no significant change with placebo. In the open label studies (n=214), mean systolic blood pressure was 162 mm Hg before, and 149 mm Hg after treatment, a decrease of 13.5 (P<0.001) mm Hg. Mean diastolic blood pressure was 97 mm Hg before, and 87 mm Hg after treatment, a decrease of 10.3 (P<0.001) mm Hg. Coenzyme Q(10) in the treatment of hypertension: a meta-analysis of the clinical trials. Rosenfeldt FL, et al. Monash University, Melbourne, Australia. Journal of Human Hypertension, 8 February 2007. For more, see CoQ10

Isosorbide mononitrate: (ISMN) in the long-term, a placebo-controlled study was performed in which ISMN was withdrawn briefly in a group of patients (n=16) who had received extended-release ISMN 60 to 120 mg once daily for 16 to 109 months. During a 4-hour delay of the regular morning dose of ISMN, mean systolic blood pressure was higher than with the regular ISMN dosing schedule (P<0.0001). The maximum placebo-active difference was 16+/-4 mm Hg. The difference in pulse pressure was 13+/-3 mm Hg (P<0.001). There was no significant difference in diastolic blood pressure. Long-Term Effectiveness of Extended-Release Nitrate for the Treatment of Systolic Hypertension. Stokes GS, Bune AJ, et al. St Leonards, NSW, Australia. Hypertension. 2005 Feb 7. Ed: This study is awful small with an odd design.

Aliskiren: New Renin Inhibitor for High Blood Pressure: A new anti-hypertensive, aliskiren (300-600 mg/d), which works at the most upstream point of the of the renin-angiotensin system did as well as irbesartan, an established ARB, at lowering blood pressure, but showed very few side-effects in an 8-week DB PC study of 652 patients. Aliskiren, a Novel Orally Effective Renin Inhibitor, Provides Dose-Dependent Antihypertensive Efficacy and Placebo-Like Tolerability in Hypertensive Patients. Gradman AH, Schmieder RE, et al. Western Pennsylvania Hospital, Pittsburgh, PA. Circulation. 2005 Feb 21.

Spironolactone Helped in Treatment Resistant: Spironolactone is recommended as fourth-line therapy for essential hypertension. In 1411 participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm who received spironolactone mainly as a fourth-line antihypertensive agent for uncontrolled blood pressure and who had valid BP measurements before and during spironolactone treatment, the median dose of spironolactone was 25 mg. Blood pressure fell from 157/85 mm Hg by 22/9.5 mm Hg (P<0.001); the BP reduction was largely unaffected by age, sex, smoking, and diabetic status. Spironolactone was generally well tolerated; 6% of participants discontinued the drug because of adverse effects. The most frequent adverse events were gynecomastia or breast discomfort and biochemical abnormalities (principally hyperkaliemia), which were recorded as adverse events in 6% and 2%. Spironolactone effectively lowers blood pressure in patients with hypertension uncontrolled by a mean of approximately 3 other drugs. Effect of Spironolactone on Blood Pressure in Subjects With Resistant Hypertension. Chapman N, et al. Sahlgrenska University, Goteborg, Sweden. Hypertension 2007 Feb 19.

Thomas E. Radecki, M.D., J.D.

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